Evaluating the effectiveness of IPTi on malaria using routine health information from sentinel health centres in southern Tanzania

Malaria Journal

Research

Pedro Alonso¹  Joanna RM Armstrong Schellenberg²  Barbara A Willey²  Hassan Mshinda³  Werner Maokola³  Kizito Shirima³  David Schellenberg³  Mwajuma Chemba³  Marcel Tanner⁴ 

[1] Barcelona Centre for International Health Research, Barcelona, Spain;Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Ifakara Health Institute, Dar es Salaam, Tanzania;Swiss Tropical and Public Health Institute, Basel, Switzerland;University of Basel, Basel, Switzerland;

关键词: Malaria;    Health Centre;    Comparison Area;    Representative Household Survey;    Tanzania National Voucher Scheme;   

DOI  :  10.1186/1475-2875-10-41

 received in 2010-09-28, accepted in 2011-02-14,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundIntermittent preventive treatment of malaria in infants (IPTi) consists of the administration of a treatment dose of sulphadoxine-pyrimethamine (SP) at the time of routine vaccinations. The use of routine Health Management and Information Services (HMIS) data to investigate the effect of IPTi on malaria, anaemia, and all-cause attendance in children aged 2-11 months presenting to 11 health centres in southern Tanzania is described.MethodsClinical diagnosis of malaria was confirmed with a positive blood slide reading from a quality assurance laboratory. Anaemia was defined using two thresholds (mild [Hb < 11 g/dL], severe [Hb < 8 g/dL]). Incidence rates between IPTi and non-implementing health centres were calculated using Poisson regression, and all statistical testing was based on the t test due to the clustered nature of the data.ResultsSeventy two per cent of infants presenting in intervention areas received at least one dose of IPTi- 22% received all three. During March 2006 - April 2007, the incidence of all cause attendance was two attendances per person, per year (pppy), including 0.2 episodes pppy of malaria, 0.7 episodes of mild and 0.13 episodes of severe anaemia. Point estimates for the effect of IPTi on malaria varied between 18% and 52%, depending on the scope of the analysis, although adjustment for clustering rendered these not statistically significant.ConclusionsThe point estimate of the effect of IPTi on malaria is consistent with that from a large pooled analysis of randomized control trials. As such, it is plausible that the difference seen in health centre data is due to IPTi, even thought the effect did not reach statistical significance. Findings draw attention to the challenges of robust inference of effects of interventions based on routine health centre data. Analysis of routine health information can reassure that interventions are being made available and having desired effects, but unanticipated effects should trigger data collection from representative samples of the target population.

【 授权许可】

Unknown   
© Willey et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.